Conventional and alternative antifungal therapies to oral candidiasis

Abstract

Candida-associated denture stomatitis is the most common form of oral candidal infection, with Candida albicans being the principal etiological agent. Candida adheres directly or via an intermediary layer of plaque-forming bacteria to denture acrylic. Despite antifungal therapy to treat denture stomatitis, infection is reestablished soon after the treatment ceases. In addition, many predisposing factors have been identified as important in the development of oral candidiasis, including malnourishment, common endocrine disorders, such as diabetis mellitus, antibacterial drug therapy, corticosteroids, radiotherapy and other immunocompromised conditions, such as acquired immunodeficiency syndrome (AIDS). These often results in increased tolerance to the most commonly used antifungals. So this review suggests new therapies to oral candidiasis.

Chlorhexidine: beta-cyclodextrin inhibits yeast growth by extraction of ergosterol

“…Although it is almost universally described as dimorphic, C.a. 's cell morphology actually lies on a pleomorphic continuum, ranging from ovoid yeast cells to filamentous hyphae (1, 2, 12, 13, 27, 42). This yeast has developed specific mechanisms of virulence that allow it to colonize epithelial cells of the host for the purpose of invading deeper layers or influencing the body's defenses.…”

Is Topical Antifungal the Appropriate First Choice for Denture Stomatitis?

“…Because of the high relapse rates of classical topical antifungals, we hypothesized which antifungal protocol would be better for DS treatment [25,26]. According to the inclusion criteria, only two study trials on patients with DS focused on the treatment with topical and systemic antifungal [1].…”

“…Systemic therapy has been prescribed for DS in cases not responding to topical agents or in cases with presence of systemic factors, such as immunosuppression or diabetes [35][36][37]. Generally, the dentists are concerned about prescribing systemic antifungals because of the risk of side effects.36 Conversely, in vivo studies reported the efficacy of systemic antifungals with minimal or no side effects to treat patients with DS through [1,21,25,38]. Interestingly, a Spanish study on drug choice for oral candidiasis demonstrated the strong predilection for topical drugs (miconazole and nystatin) by general dentists while the experts, including stomatologists frequently chosen systemic antifungals in the same cases [16].…”

Skirmishing MDR strain of Candida albicans by effective antifungal CeO2 nanostructures using Aspergillus terreus and Talaromyces purpurogenus

“…The emergence of resistant strains has been increasingly reported in recent years. Candida albicans cells are highly resistant to antifungal agents such as fluconazole, nystatin, amphotericin B and chlorhexidine [6]. The cause of resistance could be extracellular enzymes such as proteinases, phospholipases, hemolysin and lipases because they facilitate adherence and penetration to the host [7].…”